Background: Health equity remains a significant challenge in tribal-dominated regions of India due to geographical isolation, social exclusion, and inadequate service delivery. Chhattisgarh has adopted various community health nursing models—namely the Mitanin (community health volunteer), Community Health Officers (CHOs), and nurse-led primary healthcare frameworks—yet their comparative impact on access and equity is underexplored.

Methods: This study employed a mixed-methods, cross-sectional design across four districts of Chhattisgarh—Sukma, Kondagaon, Balrampur, and Balod—representing diverse geographic and demographic contexts. A household survey (n = 480) captured data on antenatal care, immunization, chronic illness management, and perceptions of equity. In-depth interviews (n = 24) with frontline health workers and structured facility observations (n = 8) were analyzed using thematic coding (N Vivo 14). Quantitative data were analyzed using SPSS v26, with equity indices, chi-square tests, and ANOVA applied to assess differences across models.

Results: Mitanin-led areas (Sukma, Balrampur) demonstrated higher community engagement, trust, and household visitation (78–83%), along with improved maternal care coverage (up to 77%). CHO-led regions (Balod) had stronger clinical service provision and higher CHW-initiated referral rates (41%) but lower outreach coverage (56%). Equity gaps persisted across caste, gender, and tribal status, with Mitanin models showing greater responsiveness to marginalized groups. Facility observations confirmed variable availability of services and equity-promoting materials across districts.

Conclusion: Community-embedded models like the Mitanin program are more effective in promoting outreach and interpersonal trust, particularly in tribal areas. CHO-based models offer clinical strengths but require improved community integration. A hybrid approach combining local trust with clinical expertise may offer a scalable pathway to advance health equity in underserved settings.